Spinoza gets entangled with severance: A call for verbification

Physician burnout is a national epidemic, as physicians are increasingly dissatisfied with their work. Some top reasons listed are administrative burden, long hours, operating bureaucracy and commoditization (productivity-based recognition or work RVUs).

The literature informs us that physician engagement has a direct correlation to the patient experience and that the patient experience has a direct correlation to clinical outcomes. Trends indicate that physicians are retiring earlier and that those in practice are becoming increasingly disengaged, as measured by standardized survey tools.

As awareness of physician and care team burnout increases among the general population, its consequences remain significant and accelerate. Burnout is often associated with clinical depression, an increase in medical errors, leaving the profession, impaired access for services and physician suicide. In fact, Medscape’s Physician Suicide Report 2022 found that one in 10 physicians considered or attempted suicide in 2021.¹ In response to the crisis, President Joe Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law in March 2022, establishing grants to promote and study ways to improve mental health for healthcare providers.² September 17 is now designated as National Physician Suicide Awareness Day.

Physicians are killing themselves at the highest rate of any profession in the United States — physician suicides are almost three times as prevalent as the general U.S. population.³ It’s a sobering fact that appears to be especially true among primary care physicians. We must absolutely leverage humanity.

The COVID-19 pandemic has accelerated the trajectory of these crises, but they have existed for a long time.

Over the course of my decades as a physician leader, I have interviewed and/or served as the hiring executive for more than a thousand physicians in multiple specialties — some on behalf of practices I owned and operated, and some on behalf of health systems, for profit and not-for-profit. The pursuit of “work-life balance” was a frequent theme among people I interviewed. Though I believe the work-life balance to be a faulty construct, the pursuit of which enhances the sense of failure and frustration, thus encouraging burnout and all its consequences.

The 17th century Dutch philosopher Baruch Spinoza^4,5 framed theories focused on the value of human happiness, the pursuit of knowledge obtained by means of reason and the evidence of the senses. Spinoza believed that the human being and knowledge serve to ground a moral philosophy centered on the control of the passions, leading to virtue and happiness — showing that our happiness and well-being lie not in a life enslaved to the passions and to the transitory goods we ordinarily pursue, but rather in the life of reason — and positing that we should strive to learn how to moderate and restrain the passions to become active, autonomous beings. 

The 2023 Medscape Physician Burnout & Depression Report, “I Cry and No One Cares,” surveyed more than 9,100 physicians across 29 specialties between June and October 2022. In the report, burnout was defined as “long-term, unresolved, job-related stress leading to exhaustion, cynicism, detachment from job responsibilities, and lacking a sense of personal accomplishment.” In the report, physicians listed three areas that they believed could reduce their burnout and depression:

• Increased compensation: 45%
• More manageable work schedule: 44%
• More support staff and respect from supervisors and colleagues: 33%.⁶

Physicians want change but also tend to fear it, primarily worried about the potential for income erosion. Yes, compensation is necessary, but with a need to change the consumption, widget producing, commoditizing emphasis. There is, unfortunately, not a one-size-fits-all formula, though the Centers for Medicare & Medicaid Services (CMS) model for physician payment reform can be the foundation upon which to establish a road map leading away from the current transactional relationship that characterizes compensation and moving toward one that may define and align incentives to achieve the aspirations of value in all scenarios.⁷

Organizational strategy in healthcare should be primarily focused on transitioning a medical group operations team (medical group) from a “noun” to a “verb” — e.g., assuring the personal and professional success of its physicians and care team members to meet the determined goals of each practice. Herein lies the opportunity for physician leaders to bridge the chasm amongst physicians, elevating their orientation from transitory and transactional to a holistic self and higher purpose, while supporting the evolution of truly meaningful goals while guiding administrative support teams to adopt dynamic measures, metrics and approaches which support this cultural shift.

Physicians must be led, taught and nurtured to understand that a higher salary is a non-sequitur for happiness and reducing burnout.

The medical group “verb” should further be active in embracing and implementing the precepts of digital minimalism,⁸ or digital decluttering, and elimination of unnecessary administrative tasks by replacing them with those that primarily focus on clinical outcomes.

Physician and Pulitzer Prize-winning author Siddhartha Mukherjee, MD, wrote, “Medicine isn’t a doctor with a black bag. It’s a complex web of systems and processes.” The physician workforce is diverse and disparate in its interests and needs.

Spinoza believed that every substance is necessarily infinite and that a substance that’s infinite is indivisible. So, too, are each of us. There is no “duality of one.” Rather than balance, we should look to models of work-life integration — the synergistic blending of the personal and professional components of our being. By enabling a shift in structure and refocusing the efforts of our leadership teams, we may accomplish the cultural shift that engages our physicians in finding their way back to a higher purpose: a patient-centered system of care. Physician, heal thyself, for your health and ours.  

Notes:

1. Yasgur BS. “A Tragedy of the Profession: Physician Suicide Report 2022.” Medscape. March 4, 2022. Available from: https://wb.md/3KAiFje.
2. “H.R.1667 - Dr. Lorna Breen Health Care Provider Protection Act.” Congress.gov. Available from: https://bit.ly/3YD5Ytx.
3. Delaveris SL. “Leverage humanity: How the deepest learning process is when technology is a tool, not a panacea.” MGMA Connection, Nov. 4, 2019. Available from: https://www.mgma.com/delaveris-humanity.
4. “Spinoza’s Life, Works, and Philosophy.” The Spinoza Web. Available from: spinozaweb.org.
5. Nadler, S. “Baruch Spinoza.” The Stanford Encyclopedia of Philosophy (Summer 2022 Edition), Edward N. Zalta (ed.). Available from: https://bit.ly/3sGK5hg.
6. Kane L. “‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023.” Medscape. Jan. 27, 2023. Available from: https://bit.ly/483OZ7Y.
7. Mechanic R, Perlman A. “Medicare Physician Payment Reform — Enhancing Incentives for Value-Based Care.” N Engl J Med. Aug. 19, 2021. 385(8):675-677. doi: 10.1056/NEJMp2106852.
8. Smith TM. “For doctors overloaded by EHRs, a new watchword: digital minimalism.” American Medical Association. April 17, 2023. Accessed at https://bit.ly/3Z4471f.